Overview of Deep Plane Facelift
The deep plane facelift is a type of cosmetic surgery procedure that was first introduced by a surgeon named Sam Hamra in 1990. This process involves a specific technique where the surgeon works underneath the surface muscle layer of the mid-area of the face, also known as the Superficial Muscular Aponeurotic System (SMAS), to reshape key facial structures and lift the outer layer of the skin.
Using the deep plane method, the surgeon applies the pull or tension at the level of the deep facial tissues, leaving the skin untouched. This means that the skin is not pulled or stretched, resulting in a more natural look and long-lasting results. This technique can also fix issues like bulging cheek fat that can give a saggy appearance to the lower part of the face.
However, there is ongoing deliberation about which facelift technique is the best. Despite the debate, when done correctly, a deep plane facelift can give dramatic improvements and lasting freshness to the middle and lower parts of the face.
Anatomy and Physiology of Deep Plane Facelift
There are several main factors that contribute to aging in the middle region of the face. One important factor is gravity. Since our skin and soft tissue are not tightly anchored, gravity tends to pull down these structures, leading to wrinkles and sag. Secondly, the face also loses volume as we age, including fat, muscle, and even bone material, which can cause sagging and hollows.
To better understand facial aging, we need to look at the different layers of the face. The superficial cervical fascia comprises the majority of facial fat and is connected to muscles like the platysma in the neck. It stretches to the midface, known as the superficial musculoaponeurotic system (SMAS). Above this, in the upper face, we have the galea.
Another layer, the deep cervical fascia, covers some deeper parts of the face including some facial muscles, nerves, and fat pads.
There is another layer known as the deep plane which separates the superficial (outer) tissue of the face, which is covered by the superficial cervical fascia, from the deeper parts of the face, which is covered by the deep cervical fascia. Key ligaments help retain the structure of our face and neck; some of these are known as the zygomatic, maxillary, masseteric, mandibular, and cervical ligaments. The facial nerve can sustain damage during a facelift surgery, particularly in certain areas. It is important to know that this nerve is located deeper than the SMAS and some facial muscles.
Lastly, the great auricular nerve, which is a sensory nerve, crosses the sternocleidomastoid muscle. This muscle is in the neck and the nerve is located roughly 6.5 cm below the outer part of the ear.
Why do People Need Deep Plane Facelift
The deep-plane facelift technique is a type of surgery that can address various signs of aging on the face, mainly concentrated in the midface region. Here are some issues that this technique can help with:
– Sagginess of the malar fat pad: This refers to a drooping or sagging of the fatty tissue in your cheek area.
– Nasolabial folds: These are the deep wrinkles or lines that run from the corners of your nose down to the edges of your mouth.
– Jowling: This condition is characterized by saggy skin or fatty tissue hanging down from the jawline. This usually results from the movement and sagging of facial tissue and fat.
– Festoons (also known as malar mounds): These are large bags of loose skin and muscle, typically resting below the rim of the eye socket. They contribute to a tired or aged appearance.
– Facial dimples: Small indentations on the face that become visible when a person smiles or talks. They are caused by facial bands from a muscle in the cheeks, or a split in the cheek muscle.
These are some of the issues that can be resolved with the deep-plane facelift technique. The surgery aims to rejuvenate the face by treating these signs of aging in a comprehensive manner.
When a Person Should Avoid Deep Plane Facelift
There is a higher risk of getting a hematoma, which is a swelling of clotted blood within the tissues, for certain individuals. These include people who:
- Take blood-thinning medications, drugs to prevent blood clots, or anti-inflammatory drugs.
- Use herbal supplements and remedies such as chondroitin, ephedra, echinacea, glucosamine, ginkgo biloba, goldenseal, milk thistle, ginseng, kava, turmeric, and garlic.
- Are men – they’re twice as likely to experience a hematoma (up to 8%).
- Have high blood pressure that isn’t well-managed, both before and during the operation.
People who smoke are also at a higher risk. If they have a facelift, they’re 12 times more likely to experience skin flap necrosis, which is the death of skin tissue. But, this might not be the case if a specific type of facelift technique, called the deep plane technique, is used.
People with Body Dysmorphic Disorder (BDD), a psychiatric condition where they’re excessively worried about minor or non-existent flaws in their appearance, might not be good candidates for facial plastic surgery. Individuals with BDD often aren’t happy with the results of their surgery and might behave aggressively or sue the surgeon. It’s found that out of the people who come for a facial plastic surgery consultation, up to 13% may suffer from BDD.
Equipment used for Deep Plane Facelift
Before Surgery
We use a local anesthetic, which is a medication given to you to numb a specific part of your body. The types we often use are 1% lidocaine with epinephrine mixture, and 0.5% bupivacaine, again with an epinephrine mix. Epinephrine helps reduce bleeding and keeps the pain relief lasting longer. If the skin around the area where the surgery is to be done needs to be expanded, we can also use something called tumescent anesthesia.
Before starting the operation, we clean the area with a product such as povidone-iodine paint. It’s an antiseptic that kills bacteria, reducing the risk of infection.
During Surgery
We use several tools during the operation. A scalpel and tissue scissors for cutting, and a special kind of scissors known as ‘facelift scissors’ are used. A multi-prong retractor is used to hold back skin and other tissues to give clearer access to the area we’re working on. When needed, we might use a lighted retractor to illuminate the surgical area.
A bipolar cautery is used to control bleeding by sealing blood vessels. We also use a closed suction drain with bulb to remove fluid or blood that collects after the surgery. For closing incisions, we use sutures, which are material like thread stitched through the skin, and occasionally, a stapler. Sutures used include SMAS (Superficial MusculoAponeurotic System) suspension and synthetic absorbable sterile surgical sutures.
After Surgery
Once your surgery is finished, we apply an antibiotic ointment to your wound to prevent infections. A compressive dressing material, which is a kind of bandage that applies pressure, helps to reduce swelling and bleeding.
Who is needed to perform Deep Plane Facelift?
The medical procedure involves a team of healthcare professionals. This includes an anesthesiologist who is responsible for making sure you stay asleep and pain-free during the operation. There’s also a surgical scrub technician, who prepares the operation room and assists the surgeon by handing them the necessary instruments. An operative nurseor circulator is present too, their role is to ensure everyone follows procedure and keeps things sterile.
Additionally, a surgical assistant plays a vital role in the operation. They help the surgeon by holding back skin or organs so the surgeon can see better (this is called “retracting”), assist in controlling bleeding during the operation, and cutting sutures, which are special threads the surgeon uses to close up an incision. These experts work together to make sure your surgery is done safely and effectively.
Preparing for Deep Plane Facelift
Before a major surgery like a facelift, doctors usually carry out some checks and preparations to make sure everything goes smoothly. These provide a clearer understanding of the patient’s current health and ensure safety during the operation.
If you have a history of depression, it’s important to be aware that these feelings might come back after the surgery. This isn’t something to worry about, people who’ve been through surgery often experience a range of emotions in the recovery period.
Part of the preparations for the surgery includes screening the nerves in your face, particularly those responsible for senses near your cheek and mouth. The doctor needs to keep a record of how these nerves are currently functioning. This helps them make sure they’ve not been affected during the operation.
A doctor might take some pictures before the surgery. These could be full face images or specific areas like your chin and neck. The aim is to clearly show the current look and structure of your face. For example, they would take a picture of you with your chin down to see how a facelift would affect the look and shape of your lower face and neck.
Doctors will also mark specific areas on your face where they’ll make the cuts for the surgery. These places are usually chosen to hide scars and maintain the natural appearance of your face, particularly your hairline.
During your surgery, you might be put completely to sleep. This decision is made based on what would be most comfortable for you. However, they often avoid using certain medications that might interfere with monitoring how your face responds during the surgery.
Just before your surgery, you might be given an antibiotic. This is a precaution to prevent any infection caused by bacteria on the skin. You might also get an injection that could help reduce any swelling post-surgery.
Lastly, the doctor will numb the areas where they are planning to operate to ensure you don’t feel any pains during the procedure.
How is Deep Plane Facelift performed
Deep plane rhytidectomy, also known as a facelift, is a surgical procedure that helps to rejuvenate the midface, jawline, and neck. Here is a simplified explanation of this procedure using a popular technique called the sub-SMAS lift.
First, the surgeon makes incisions in the skin as planned. They lift the skin layer just a bit from the underlying tissue using special instruments like facelift scissors or a scalpel. This is done carefully so that nerves that could be harmed aren’t disturbed.
Next, the surgeon cuts into what’s known as the ‘superficial muscular aponeurotic system’, or SMAS, a tissue layer from the jawline to the rim of the eye socket. Now the surgeon eases the skin and SMAS layer away from a tough layer called parotid-masseteric fascia. Crucial ligaments located near the masseter muscle (a large muscle on the side of your jaw) are released to continue the procedure smoothly.
This is where the focus shifts upward. A pocket is created along the eye muscle (orbicularis oculi muscle) area and safely extended towards the nose and upper lip (premaxillary space). At this stage, the skin and the cheek fat pad come together. Here, the top layer of a muscle called the zygomatic major muscle can be clearly seen.
All the ligaments attached to this zygomatic muscle are cut with care not to harm the facial nerve branches that power this muscle. The deeper dissection keeps going along the zygomatic muscle till it reaches the area that has formed the wrinkles from your nose to the corners of your mouth (nasolabial fold). This step creates a released, flexible midface.
If the surgeon observes excessive jowling due to fat poking through the surrounding tissues (buccal fat pseudo-herniation), it is fixed at this stage. Tiny amounts of the protruding buccal fat are cut away, making sure not to injure nearby facial nerve branches.
Then, the SMAS layer is suspended or pulled upwards through specific suturing techiques, from bottom to top. Once that’s done, any extra skin is carefully cut away and pulled in the same direction to allow for a relaxed skin closure. Different types of stitches are used to close the skin layer perfectly, preserving the hairline and recreating the natural hollow shape around the ear area. Throughout, the surgeon is careful not to pull the stitches too tight, which would cause pixie ear deformity, or the ear lobe to pull downward unnaturally.
Before the final closing up, a small tube is inserted just behind the hairline to collect wound fluids, which is then removed a few days post surgery. The last steps involve the application of antibiotic ointment and a compressive facelift dressing, completing the procedure.
Possible Complications of Deep Plane Facelift
In a process of deep-plane dissection, a well-nourished flap of skin is created and used in facelift procedure. This method provides a greater protection against potential issues that might accompany facelift surgery. Nevertheless, the following complications could still occur:
* Hematoma formation: This is when a collection of blood that looks like a large bruise, known as a hematoma, forms. It happens in less than 2% of facelift surgeries. If it does happen, doctors must act quickly to prevent harm to the skin flap.
* Infections: This happens in less than 1% of cases.
* Skin slough: This is when a layer of skin peels off. This occurs in less than 3% of cases, and most often behind the ear.
* Facial nerve injury: In less than 1% of cases, the facial nerve may be harmed. The rate is about the same as with traditional facelift surgery.
* Great auricular nerve injury: This nerve, which affects sensation of the earlobe, gets hurt in up to 7% of cases. This could cause numbness in the earlobe.
* Pixie-ear deformity: This is when the ear appears pulled forward or downwards because the skin under the earlobe was stretched too much during surgery.
* Alopecia: This is hair loss, which can be prevented with careful incisions along the hairline and avoiding the use of a cautery (medical device that burns tissue) near the hairline.
Finally, another uncommon complication is the first bite syndrome, which may occur due to injury to the nerves in and around the salivary gland. This might cause pain when a person takes their first bite of food.
What Else Should I Know About Deep Plane Facelift?
A deep plane facelift is a great method used to bring back a lively and refreshed look to an aging face. During this procedure, it’s important for your doctor to properly assess your needs and carefully follow a detailed treatment plan rooted in your body’s own biological structures. This guarantees safe and pleasing results, which can be trusted and relied upon.